Diagnostische Stabilität bei Autismus-Spektrum-Störungen und mögliche Prädiktoren für einen Diagnosewechsel auf Item-Ebene der Diagnostischen Beobachtungsskala für autistische Störungen- eine deskriptive Analyse

Die Autismus-Spektrum-Störung (Autism spectrum disorders, ASD) gehört zu den neuronalen Entwicklungsstörungen und beeinträchtigt Betroffene deutlich in ihrem Alltag. Daher ist eine präzise Diagnostik unabdingbar, um die Betroffenen bestmöglich unterstützen und therapieren zu können. Allerdings weise...

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Bibliographic Details
Main Author: Crommelinck, Julie
Contributors: Kamp-Becker, Inge (Prof. Dr. phil.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2023
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Autism spectrum disorders (ASD) belong to the group of neuronal developmental disorders and significantly impair affected individuals in their daily lifes. Therefore, a precise diagnosis is essential in order to provide the best possible support and therapy for those affected. However, ASDs do not exhibit complete diagnostic stability. This means that patients who initially receive an ASD diagnosis may later relinquish it because they no longer meet the diagnostic criteria, or that patients may initially receive a different diagnosis or no diagnosis at all and only later be diagnosed with an ASD. This results in four diagnostic groups: ASD stable (patients who stably receive an ASD diagnosis), NON-ASD stable (patients who stably do not receive an ASD diagnosis), ASD to NON-ASD (patients who change from an ASD diagnosis at the first measurement point to no ASD diagnosis at the second measurement point), and NON-ASD to ASD (patients who change from an ASD diagnosis at the first measurement point to an ASD diagnosis at the second measurement point). Various factors that influence diagnostic stability or allow conclusions to be drawn about whether someone gives up or receives a diagnosis in the course of time are described in this thesis (cf. Chapters 3 to 3.3.5). The present thesis examines a central component of autism diagnostics - the ADOS. In the sense of a descriptive review, the question is addressed whether there are certain items of the ADOS which differ in their expression or development between the diagnostic groups and can thus serve to characterize the individual groups. This will serve as a cornerstone to identify valid predictors for assignment to individual diagnostic groups in further studies. With this in mind, 12 cross-module items as well as the individual scales of the ADOS are examined. In addition, the thesis examines two of the transdiagnostic factors that influence diagnostic stability. First, the age at diagnosis, and second, the relationship between the development of language skills and communication or social interaction. The research shows that among the cross-module items there are two items that differ significantly between the diagnostic groups: the items ENJ (shared enjoyment of interaction) and EYE (unusual eye contact). On the scale level, there is a different expression in the diagnostic groups for the scale "Social Affect" (SA) as well as the Comparison Score (comparison value of the ADOS to make ADOS values comparable across different modules). The expression of the scale "Restrictive and Repetitive Behaviors" (RRV) does not differ significantly between the diagnostic groups. A positive correlation between the development of language skills (measured by the items NESL ; total level of non-echolalic speech and IECHO ; immediate echolalia) and the development of communication or social interaction (measured by the SA score) can be shown for the item NESL. The raised hypothesis that affected persons in the diagnosis group NON-ASD to ASD are younger at the time point of the first diagnosis than those in the other diagnosis groups cannot be proven in the present work, but a positive correlation between the distance of the measurement time points and the decrease of the scale SA respectivly the Comparison Score is shown. The results of the work at the scale level underline the validity of the ADOS as well as its central role in the diagnostic process. However, it is clear that the RRV scale is not suitable for distinguishing the diagnostic groups from one another. This is predominantly due to the fact that restrictive and repetitive behaviors are only slightly pronounced across all diagnostic groups. On the item level, the results bring the area of reciprocal social interaction of the scale SA particulary into focus. The items ENJ and EYE should be evaluated as possible predictors, as well as other non-crossmodule items from the domain of social affect. Although none of the language-related items shows differences in expression among the examined items, the described correlation between linguistic abilities and SA score suggests that linguistic abilities nevertheless influence diagnostic stability. The investigation of further non-crossmodule language-related items is reasonable at this point. Also, possible reasons for the positive development in affected individuals with a larger gap between the two measurement time points (for example, therapy duration or maturation) should be investigated in further work. Based on the results of the present work, further hypotheses arise, especially with regard to the items ENJ and EYE. The results form an important cornerstone on the way to identifying valid predictors for diagnostic group membership.